Doctor. I'm sending you in this elderly woman - a Miss Twill. The policeman on his rounds noticed that her usual light wasn't burning. He found her unconscious on the kitchen floor. I'm not sure how long she's been out. Anyway, I've called for an ambulance. She should be with you in half an hour."
"Is it a cerebral haemorrhage?"
"I don't think so."
"She isn't a diabetic by any chance?" Lesley was racking her brains for all she knew about the causes of loss of consciousness.
"I thought of that. Unfortunately, her own doctor's on holiday - I'm just here on an emergency service call. I've spoken to the neighbours, of course, but they're new to the district. No one knows about the previous medical history. Apparently her brother died a couple of weeks back. They seemed to keep themselves very much to themselves. That's as much as I could learn. Afraid it's not much help. The coma's pretty deep. I don't have facilities here for further investigation. She's really a case for hospital admission."
"Of course. We'll do what we can."
Lesley went back to her room to finish dressing. After the lovely day there was now a distinct nip in the air. The past month had flown; yet in another way it seemed as if she'd been here for ages, almost as though the summer holiday had never been.
As she stepped out into the courtyard she was already reviewing all that she'd ever learned on the subject of coma. "A.E.I.O.U." - she was grateful now for the mnemonic - apoplexy, epilepsy, injury, opium, uraemia, drink, drugs and diabetes. From what the doctor had said she couldn't really exclude any one of these yet.
When she reached the ward she found Nurse Duncan on her first spell of night duty. She warned her to prepare for an unconscious patient.
At half-past eleven at night she had her hand on a cold, white, clammy arm as Miss Twill was wheeled on a trolley into the corridor of Ward Two.
"You the doctor, miss?" The ambulance man was fumbling in the breast pocket of his tunic. "There's a line here from the G.P." He handed Lesley a crumpled note.
Her face lifted. "The family doctor got back in time?" He would almost certainly know what the diagnosis was.
She tore open the envelope, but it was only the confirmatory letter from the doctor who had spoken to her on the phone. It contained no new information at all.
"If a general practitioner of some years' experience doesn't know what's wrong, how can I hope to make a diagnosis?" She found she had spoken her doubts aloud.
"Doctor?" She became aware of Nurse, Duncan's anxious expression. "We don't have an empty bed left in the side room. I've had to put her into the ward. Is that all right?"
"Yes, of course, Nurse." Lesley braced herself. "Let's have a look at her now." She led the way through the swing doors into the darkened ward.
A single light in the centre cast pools of shadow on the rows of beds. Behind white screens, just inside the entrance, Miss Twill lay heavy and inert. When they tried to move her she was a dead weight.
"We'll see if we can rouse her first." Lesley raised the eyelids and shone her pocket torch. There was no response. She pinched the skin, then shook the patient gently by the shoulders.
"Miss Twill, Miss Twill! Wake up," she whispered urgently. The soft even breathing coming from the surrounding beds warned her to lower her voice. She turned to the nurse.
"Bring some of the flowers - strong-smelling ones if possible."
Jane Duncan looked puzzled, but scurried off without questions.
"Will these do, Doctor?" She returned with a bowl of delicately fragrant pink roses.
Lesley wafted them in front of her patient's insensible nose. At last she straightened.
"It's no use, Nurse. We're not getting through to her. All five gateways to the mind are closed."
(Cold, pale, clammy - it should be an insulin coma. The signs were all there, almost classical, it seemed.)
"If only we knew she was on the stuff!"
"The stuff?" In her searchings she'd forgotten the nurse again.
"Is it a cerebral haemorrhage?"
"I don't think so."
"She isn't a diabetic by any chance?" Lesley was racking her brains for all she knew about the causes of loss of consciousness.
"I thought of that. Unfortunately, her own doctor's on holiday - I'm just here on an emergency service call. I've spoken to the neighbours, of course, but they're new to the district. No one knows about the previous medical history. Apparently her brother died a couple of weeks back. They seemed to keep themselves very much to themselves. That's as much as I could learn. Afraid it's not much help. The coma's pretty deep. I don't have facilities here for further investigation. She's really a case for hospital admission."
"Of course. We'll do what we can."
Lesley went back to her room to finish dressing. After the lovely day there was now a distinct nip in the air. The past month had flown; yet in another way it seemed as if she'd been here for ages, almost as though the summer holiday had never been.
As she stepped out into the courtyard she was already reviewing all that she'd ever learned on the subject of coma. "A.E.I.O.U." - she was grateful now for the mnemonic - apoplexy, epilepsy, injury, opium, uraemia, drink, drugs and diabetes. From what the doctor had said she couldn't really exclude any one of these yet.
When she reached the ward she found Nurse Duncan on her first spell of night duty. She warned her to prepare for an unconscious patient.
At half-past eleven at night she had her hand on a cold, white, clammy arm as Miss Twill was wheeled on a trolley into the corridor of Ward Two.
"You the doctor, miss?" The ambulance man was fumbling in the breast pocket of his tunic. "There's a line here from the G.P." He handed Lesley a crumpled note.
Her face lifted. "The family doctor got back in time?" He would almost certainly know what the diagnosis was.
She tore open the envelope, but it was only the confirmatory letter from the doctor who had spoken to her on the phone. It contained no new information at all.
"If a general practitioner of some years' experience doesn't know what's wrong, how can I hope to make a diagnosis?" She found she had spoken her doubts aloud.
"Doctor?" She became aware of Nurse, Duncan's anxious expression. "We don't have an empty bed left in the side room. I've had to put her into the ward. Is that all right?"
"Yes, of course, Nurse." Lesley braced herself. "Let's have a look at her now." She led the way through the swing doors into the darkened ward.
A single light in the centre cast pools of shadow on the rows of beds. Behind white screens, just inside the entrance, Miss Twill lay heavy and inert. When they tried to move her she was a dead weight.
"We'll see if we can rouse her first." Lesley raised the eyelids and shone her pocket torch. There was no response. She pinched the skin, then shook the patient gently by the shoulders.
"Miss Twill, Miss Twill! Wake up," she whispered urgently. The soft even breathing coming from the surrounding beds warned her to lower her voice. She turned to the nurse.
"Bring some of the flowers - strong-smelling ones if possible."
Jane Duncan looked puzzled, but scurried off without questions.
"Will these do, Doctor?" She returned with a bowl of delicately fragrant pink roses.
Lesley wafted them in front of her patient's insensible nose. At last she straightened.
"It's no use, Nurse. We're not getting through to her. All five gateways to the mind are closed."
(Cold, pale, clammy - it should be an insulin coma. The signs were all there, almost classical, it seemed.)
"If only we knew she was on the stuff!"
"The stuff?" In her searchings she'd forgotten the nurse again.
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